Katie McCabe - Vivien Thomas

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O M E T H I N GTHE _ O R D

'Vivien Thomas Nev er Went to ' College,

But He HaG ' : ; t .GenilJs~a S tunn ing Dexte rity .

He Might Have Been a Grea t Surgeon.

Instead, He Became a Legend.

~

By Katie McCabe

S a y his name, and the busiest heart sur-

geons inthe world will stop and talk for an hour. Of course they havetime, they say, these

men who .count, time in seconds, who race against the clock. This is about Vivien

Thomas. For Vivien they'Il make rime.

Dr. Denton Cooley has just come out of surgery, and he has 47 minutes between

operations. "No, you don't need an appointment," his secretary is saying. "Or.

Cooley's right here. He wantsto talk to you now. "

Cooley suddenly is on the line from his Texas Heart Institute inHouston. In a slow

Texas drawl he says hejust loves being bothered about Vivien. Andthen,in47 minures=-

Augus t 1989fThe Wash ing tonian 109

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just about the time it takes him to do a triplebypass-he tells you about the man who taughthim that kind of speed.

No, Vivien Thomas wasn't a doctor, saysCooley. He wasn't even.a college graduate. He

was just so smart, and so skilled, and so muchhis own man, that it didn't matter.

And could he operate. Even if you'd neverseen surgery before, Cooley says, you could-doit because Vivien made it look so simple.

Vivien Thomas and Denton Coo-ley 'both ani ved at Bal t irnore ' sJohns Hopkins Hospital in 1941-Cooley to begin work on his medi-cal degree, Thomas to run th e hos-pital's . surgical lab under Dr ,

Alfred Blalock. In 1941 the onlyother black employees at the JohnsHopkins Hospital ~.ele janitors.People stopped and 'stared atThomas, flying down corridors in

his white lab coat. Visitors' eyeswidened at the sight ofa black manruni1i~gthe lab. But ultimately thefact tHatThomas was black didn't

matter, either. What mattered wasthat Alfred Blalock and Vivien'fbom~ could do historic thingstogether that neither could doalone,

Together they devised an op-eration to save "Blue .Babies " -infants born with a heart defectthat sends blood past their lungs-and Cooley was there, as an in-tern, for the first one. Heremern-bers the tension in the operating room that.No-

vember morning in 1944 asDr. Blalockrebuilt alittle girl's tiny, twisted heart.

He remembers how' that baby went from

blue to pink the minuteDr. Blalock removed theclamps and her.arteries began to function. Andhe remembers where Thomas stood-von a littlestep stool, looking over Dr. Blalock's rightshoulder, answering questions and coaching ev-

ery move.

"You see," explains Cooley, "it was Vi-vien who had worked it a ll out in the lab, in thecanine heart, long before Dr. Blalock did Ei--

leen, the first Blue Baby. There were no 'car-diac experts' then. That was the beginning . ' ,

A loudspeaker summons Cooley to surgery.

He says he's on his way to do a "tit case" right

now. That 's tetralogy of Fallot, the congenitalheart defect that causes Blue Baby Syndrome.They say that Cooley does them faster thananyone, that he can make a tetralogy operationlook so simple it doesn't-even look like' surgery."That's what I took from Vivien," he says,"simplicity. There wasn't a false move, not awasted motion, when he operated. "

But in the medical world of the 1940s'thatchose and trained men like Denton Cooley,

there wasn't supposed to be a place

for a black man, with or" without adegree. Still, Vivien Thomasmade a place for himself. He was !Iteacher to surgeons at a time whenhe could not become one. He was acardiac pioneer 3. 0 years beforeHopkins opened its doors to (hefirst black surgical resident.

Those are the .facts that Cooley

has laid' out, as ,swiftly and, effi-ciently as heoperates. And yethistory argues that the VivienThomas story could never havehappened.

In 1930, Vivien Thomas was anineteen-year-old carpenter's ap-prentice with his sights set on Ten-nessee State College and thenmedical school. But the depres-sion, which had halted carpentrywork in Nashville, wiped out hissavingsand forced him to post-pone college. Through a "friendwho worked at Vanderbilt Univer-sity, Thomas learned of an open-

ing as a laboratory assistant fora young doctornamed Alfred Blalock=whowas ,cjn his friend 'swords, "hell to getaIong with." Thomas decideed to take a chance, and E m February 10,. 1930,

he walked into Blalock's animaLIab.Out came Blalock, a Coke in one hand,cigarette in the other. A remote cousin of Jeffer-son Davis, Blalock was in many ways a South-ern aristocrat, flashing an ebony cigarette hold-er and smiling through clouds of smoke. But the30-year-old surgeon who showed Thomas intohis office was even then, Thomas said, "a manwho knew exactly what hewanted. "

Blalock saw die same quality in Thomas,who exuded a no-nonsense attitude he had ab-sorbed from IU s hard-working father. The well-spoken young man who sat on. the 1ab stoolpolitely responding to Blalock's questions hadnever been in a laboratory before. Yet he wasfull of questions about the experiment inprogress, eager to learn not just ,.wha t" but"why" 'and "how." Instinctively, Blalock re-sponded to that curiosity ,describing his experi-ment ashe showed Thomas around the lab.

Face to face on twolab stools, each told theother what he needed. Thomas needed a.job, hesaid, until he could enter college the next-fall .Blalock, well into his groundbreaking work onshock-the first phase of the body's reaction totrauma-s-needed "someone in the lab Whom Ican teach to do anything Lean do, and.rnaybedothings I can't do. "

Katie McCabe haswritten about good teachers andmany

other subjects for The Wash ing ton ian" Four years ago

while reporting a medicalstory, sheinterviewed Dr.Judson Randolph, chief of surgery at Children's Hospital,who told her aboutVivien Thomas, a legendary,black

man who trained many of the country's top surgeons. Ayear. later , she inquired about Thomas at Johns Hopkins

Hospita l; and foundhe had died the day Randolph hadsuggested the story. Shealmost gave upon writing aboutThomas but went ahead when she discovered his 'auto-biography and the transcript ofa 1967 interview. Shetheninterviewed Thomas 's family ,coworkers, and students.O f t he m any people who gave oftheir 't ime and enthusi-asm, the author wishes especially to acknowledge the

contributions of Dr. Mark Ravitch, who until h is death in

March was surgeon-in-chief atPiusburgh's.Montefiore

Hospital.

110 Th e Washingtonian/August 1989

~

T he 1,O O O thBlue Baby

operation

was a

happy occasion

fo r Vivien

Thomas andsurgeon Alfred

B lalock, w ho is

pictured herewith one of the

babies in a

Yousu f K a rsh

portrait.

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.Each man got .more than he bargained for.

With in th re e: days, Vivien Thomas was per-forming a lm ost as ifhe'd been born in the lab,

doing .arterial punctures on the laboratory dogsand rneasuringand administering anesthesia,Within-a month, the former carpenter was' set-

ting l IP e xp er iment s an d p er fo rm ing td el ic a te san d

complex operations.

Blalock could see Thomas had a talent for sur-gery and a .keen :intelle.ct, but he

was n ot to see the full measure ofth~ mall he'd hired until the dayT ho ma s m ade his first mistake.

"Something wen; wreng, "

Thomas later wrote inhis auto-

biogr:ap'hy _ '"I no l"onger -recall'w hat, but I m ade some erro r. D Jj.

Blalock sounded 0£f like a GhiMtbro wing a tem per. ta ntrum . The

profanity he usted would havemade die proverbial sailor proud

of him .... l told him he c0l,11oJustp a y m e off .: :.. that r had not beenbrought up to take 01use-that-kindoflanguage .... He apologized"

saying.he had lost his temper, thathe would watch.his.Jarrguage, andh-e,asked me togo back to werk, "

Erom that da y on , said Thom-as, " ne it he r.e ne o fm s- ev er h es it at-

ed toteli the other,' ina straightfor-

ward man-to-man manner what-'heth~ught or now he felt. ~ .. Inretrospect, l' think th at inciden t set

th e stage JOlc, what 1 conside;,r:ou r

mutual respect throughout the

years. '.J •

For 34 years they were a rem arka ble co mbi-

na tio n: B la lo ck the scientist, asking the gues-tio ns ; 1 fh om a s th e pragmatist, figuring out tIlesimplest way to. .get the answers. A:( their b)ack-

top~d workbench and eignt animal opeta~ing

!lib les , th e tw o se t.o ut t0 ' disprove all the dIeexplanations' about shock, amassingevidencethat eonnected it to a decrease in blood volume

and.fluid loss outside th e vascular bed.

In a few ye;rs, die e~lami.tionsBlalock was

d e¥ ei oR ing wou ld lead to massive applications

o fb looo <Lnd 'p la sma t ran sf us ion -I n t he tr ea tment( ' I f shock, MetliodicalLy, fr:om their Jab at "thats choo l d l .' lwi l in, the backwoods" -a s Blalockc:illeu Vianderbilt_:_heandTho~~ w:ere altering ,

physiology,

A ll th at was inside the laboratory. O utsideloomedthe Depression, Ina world'where "menwere w alking the streets lo oking for jobs that

didn't exist,' Thomas. watched his own collegean d medical-school plans evaporate. "I was out

of sebeolfor the second year;' he wrote, "but I

~Gmehowfelt that tlfings might change in myfavor,' ... B ut it didn't happen." With each

passing-month, Thomas's hopes dimmed, some-

thing. not lost on Blalock. The two men dis-

cussed it, a nd T hom as finally decided tha t evenif he someday could afford college" medicalSCh00l now seemed out of reach. B y 1931-,'l1bomas had-made his peace. "Fol' the time

lleing," he said, "I felt secure in.that, at least, 1

h ad a jo b. Things were-getting to th e point that itseemed to be a matter of survival. "

But the young m a i l . who read 'Chemistry and

physiology textbooks by da y a nd m onitored ex-periments by night was doing more thansurviv-ing. For $12 a week, with no overtime pa y fo r

sixteen-lrour days and ne prospect ofadvance-

ment or recognition, another man might have

su rv ived. Thomas .exce lled,

Coached 1 : \ : i y Blalock's yeung research fel-low , Dr. Joseph Beard , Thomasmastered anatomy' and physiolo-

gy, and he plunged into Blalock's

round-the-cIockl'esear.ch. At 5

PM, when everyone else w as le av -ing. l1homas and "The Professor"prepaned to wOllR on ilnte to enight-Thomas setting up the trea-sured V an S lyke rna eh ine used to

measure blood oxygen, Blalock

starting the S i p - n o D o n the ten~gal-toneharred keg of wfiiske~be kepthidden-in the laoorat@ly storeroom

during Peohibition. Then.as theysettled dow n to m onito r a ll-n ightshock expeaments, Blalock an,d,

Th0mas would relax w.ith a whis-key-and-Coke.

~

Although Viv ienT,h€)mHS

recei~€tl 'little

public acclaim,

the men and

women he

trained were

quick to

acknowledge

their debt tohim. Above, hewatches over

two surgical

assistants.

BHu0Ck and T homas knew tne SO-.

e ia l c od es and traditions oftlie O ld

South. THey undefsto0d the lineJj~~weenlife inside the.lao, wherethey could drink tog~tliell in 1930,

and life .outside, wbere tbey eould

not. Neither onewas to cross thatline, Thomas attended Blaleek/s

parties as a banendef;, mootuighiing fo r extraincome. In 196fih,!hen Blalock' celebrate.d hi's

60tfi birthday at Baltimore's Southern Hetel,T homas was.not p resent, .

Within the lab) t he y f un ct io n ed almost as asingle. mina., as 'vhornas's deft ha nds turnedBI~lock's ideas into elegant and detailed expeti-

ments, In the verbal shorthand they developed,

Thomas learned to translate Blalock's "I won-

de r what would happen if" into step-by-stepscientific protocols. Through hundreds of ex-

periments, Blalock wondered and Thomas

found out, until in 1933 Blalock was ready-to

challenge the medical establishment with hisfirst "named lecture."

Almost overnight, Blalock's shock theorybecame "more or: less Gospel;" as Thomas putit. B y 1935, ahandful of ·other scientists had

begun to rethink the physiology-of'shock, butnoon e besides Blalock ha d attacked the problem

from so many angles. N0one else had compiledsuch a mass of data on hemerrhagic.aad trau-

matic shock. No :one else had been able to ex-plain such a co mplex plienomenon so sim ply .

And noother scientist had a Vivien Thomas .In his four y ea rs w ith Blalock, T hom as had

assumed the role of a s en io r r es ea rc h fellow,with neither a.PhD nor an MD. But as a black

man doing highly technical research, he hadnever really fi t into the system-a realitythat

became painfully clear when in a s al ar y d is cu s-C on tin ue d o '1 pa ge 2 26

A ugu st 1 98 9lT I1 e W as h in gt o n ian .111

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Some th ing . t h e Lord M ad eContinaedfrom page JJI

sionwith a black coworker, Thomas dis-covered that Vanderbiltclassified him asajanitor.He was careful but firm when he ap~

preached Blalock 0U the issue: "'1 toldDr. Blalock ... that for the typeof workI was doing, I felt I should be ... putQU

the pay scale of a technician, which Iwaspretty sure was higher than janitor pay, "

Blalockpromised to investigate. Afterthat, ".nothing more was-ever said aboutthe matter," Thomas recalled. Whenseveral paydays later Thomas and hiscoworker received salary increases, nei-ther knewwhether tie had-been reclassi-fied as a technician qr just given moremoney be~ause Blalock demanded it.10 the world in which Thomas had

grown up, confrontation could be d a n -gerous for a black man. Vivien's olderbrother, Harold, had been a schoolteacher in Nashville. He had sued the

Nashville Board of,Education, allegingsalary discrimination based on race.With the help of an NAACP lawyernamed Thurgood Marshall. HaroldThomas had won his suit. But he lost hisjob. So' Vivien had learned the art ofavoiding trouble .. He recalled: "Had

there been an organized complaint by theNegroes performing technical duties,there was a good chance that all kinds ofexcuses would have been offered toavoid giving us technicians' payand thatleaders of the movement or action wouldhave been summarily fired. "Thomas had family obligations to

consider, too. In December 1933, after a

whirlwind courtship, he had married ayoung woman from Macon, Georgia,named Clara Flanders ..Their first child,Olga Fay, was born the following year,and a second daughter, Theodosia,would arrive in 193'8. .

The satisfaction of making a publicracial statement was a luxury Thomaswould 'not have for decades, and even.then fie would make his point quietly.Meanwhile, he worked hard, makinghimself indispensable to Blalock, and inso doing he gained a powerful ally with-in the system. When they confronteddiscrimination again, they confronted ittogether.

The test of their partnership was not longin corning. In1'937, Blalock received anoffer of a prestigious chairmanship fromHenry Ford Hospital in Detroit. As sur-geon-in-chief there, he could run hisown department, train his own.men, ex--pand his research. .He and Thomas' were a package deal,

Blalock told the powers at Henry Ford.ID that case, the answer came back, there

22 6 "tlieWashingtonianiAugust1989

would be no deal. The hospital's policyagainst Hiring blacks was inflexible. Sowas hispoJicy on Vivien Thomas, Bla-lock politely replied.Tile two bided -their time, teaching

themselves vascular surgery in experi-ments in which they'attempted toproduce pulmonary hypertension indogs. The hypertension studies, as such,"were a.flop;" Thomas said. But they

He and Thomas w ere a

package de al,t 1l alo ck t old

th e hospital . In t ha t c as e,

the answ er cam e b ack ,

there w ou ld b e n o d eal.

Thei r policy ,against hiring

b lack s w a s inflexible.

we're one of the most productive flops in

medical history .By 1940, Blalock's research had puthim head and shoulders above any youngsurgeon in America. When the call cameto return to his alma mater, Johns Hop-kins, as surgeon-in-chief, lie was able tomake a - deal on his, own terms, and itincluded Thomas. "} want you to gowith me to Baltimore, " Blalock toldThomas just before Christmas 1940.Thomas, always his own man, replied,"1will consider it. "Though Blalock would take a pay cut;

the-move to Hopkins offered him pres-tige and independence. For the 29-year-old Thomas and his family, it meant

leaving the home they had built 'inNash-ville for a strange city and an uncertain.futur~.

In the end, it was World Wal"nthat

caused Thomas to ,.,take, his chances"

with Blalock. If he were drafted, itwould be to his advantage to be at Hop-kins, Thomas decided, because hewould probably be placed with a medicalunit. Always the family man, he wasthinking practically. So Blalock, witheverything to gain, and Thomas, with"nothing to lose," as he put it, madetheir move together.When they came to Hopkins, they

brought with them-solutions to the prob-lems of shock that would save manywounded soldiers inWorld Warn. Theybrought expertise in vascular surgerythat wouldchange medicine. And theybrought five dogs, whose rebuilt heartsheld the answer to a question no one yethad asked.

When Blalock and Thomas arrived inBaltimore'm 1941, thequestions onmostpeople's minds had nothing to-do with

cardiac surgery. How on earth was thisboyish professor of surgery going to runa department, they wondered. With hissimple questions and his Georgia drawl,Blalock didn't sound much like the gold-en boy described in his letters of refer-ence. Besides, he had brought a colored

man up from Vanderbilt tel run his lab. Acolored manwho wasn't even a doctor.Thomas had doubts of his 'own as he

walked down Hopkins's dimly lit corri-

dors, eyed the peeling green paint andbare concrete floors, and breathed in theodors of-the ancient, unventilated. struc-ture that was to' be his workplace; theOld Hunterian Laboratory. One look in-side the instrument cabinet told hun thathewas in the surgical Dark Ages.ItWas enough to make him want to

head back to Nashville and take up hiscarpenter's tools again. After a day ofhouse-hunting in Baltimore, he thoughthe might have to. Baltimore was moreexpensive than either he or Blalock hadimagined. Even with a~20percent .il)-

crease over, his Vanderbilt salary,

Thomas found it "'almost impossible toget along. " Something would have to bedone, he told Blalock.Blalock had negotiated both of their

salaries from Nashville, and now the4elrlcould not be renegotiated. Itseemedthat they were stuck. "Perhaps youcould discuss the problem with yourwife," Blalock suggested. "Maybe she

could get a job to help out. ;,

Thomas bristled. His father was abuilder who had supported a family ofseven. He meant todo at least-as wellforhis own family. ''lntend for-my wife totake care of our children," he told Bla-lock, "and IhinkIave the capability tolet her do so-except Imay have thewrongjob. "If neither Hopkins nor Thomas would

bend, Blalock would have to find anoth-er way to solve the problem. Blalock wasnot wealthy, but he had an ally at HOp-kins, world-renowned neurosurgeon Dr.Walter Dandy, who was known for hisgenerosity. That afternoon Blalockpresented his situation to Dandy, whoresponded immediately with a donationto the department-earmarked forThomas's salary _So Thomas' ordered his surgical sup-

plies, cleaned and painted the lab; put 0Dhis white coat, and settled down to work.On his first walk from the lab to Bla-lock's office in the hospital across cam-pus, the Negro man in a lab coat haltedtraffic. The hospital had segregated rest-rooms and a-back entrance for blackpatients. Vivien Thomas surprised Johns

Hopkins.Inside the lab, it was his skill that

raised eyebrows. What he was, doingwas entirely n:ew to the two other Hop-kins lab technicians, who were-expected

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jUsMo,et.upexperiments for the medicalinvestigators,tocarry out. How long hadhebeen doing this, they wanted to know.Howand wherehad he.learned?Then, one morning in. 1943, while

Johns-Hopkihsand Vivien Thomas were.still.getting-used to.eaeh other, someoneaskeda question that would change sur-gicalhistory .

For this part of the,story, we have Thorn-as's.own voice. on tape-deep; rich, and

full of soft accents. Inan 'extensive 1967interview with medicalhistorian Dr. Pe-terOlch, werneer'the.warm, wry VivienThomaswho remains hidden behind theformal, scientific prose of-his autobiog-raphy. He tells the Blue Baby story so.

rnatter-of-factlythat you forget he's out-l iningthe beginningofcardiac surgery.For once, itwasn't Blalock who asked

thequestion that started it.all. Itwas Dr.Helen Taussig, a Hopkins cardiologist,Whocame to Blalock and Thomas look-ing for help for. the cyanotic babies shewa s seeing. At birth these babies becameweak and "blue,] and sooner or laterall

died. _Surel)..-theie had, to he a-way to"change the pipesaround." to bringmore blood to their lungs, Taussigsaid,There was, silence. "The Professor

a nd I just looked at each other. We knew -we had .the answer in the Vanderbiltwork, '" Thomas says, referring to theoperation he and Blalock had worked outatVanderbilt some six yearsearlier-vthe"failed" experiment in which they haddivided a major artery and sewn it intothe pulmonary arter-y that supplied. thelungs. The procedure. had not producedthe hypertension model they had sought,but it had rerouted the-arterial blood into

the lungs. It might be the solution forTaussig's Blue Babies.But '.'might" wasn't. good enough.

Thomas first would have to reproducetetralogy of Eallot in the- canineheartbefore the effectiveness oftheir "pipe-

changing" could be tested.Off he. went to the Pathology Mu-

seum, with its collection of congenitallydefective hearts, For-days, he went overthespecimens=tiny hearts so deformedthe.y 'didn't even look like hearts. Socomplex was the four-part anomaly ofPallet 's.tetralogy thatrl'homas thought itpossible to reproduce only, two of the

defects, at most. "Nobody had fooledaround with the heart before," he says,"_so we had no idea. what trouble we

might get into. Iasked The Professorwhether we couldn't find-an easier prob-lem to work on. He told me, 'Vivien, allthe:easy things have.beendone.' "Taussig's question was asked iJ1.1943,

and 'for more than a year it consumedBlalock and Thomas, both by then work-ing in the Army's shock research .pro-gram. Alone in the lab, Thomas set

about repljcatiag-the Blue Baby defect ihdogs and ans weringi two 'questions :Would the.Vanderbilt procedure relieve-cyanosis? WO.uldbabies-survive it?

As he wasworking out the final details inthe dog lab, a frail; cyanoticbaby namedEileen Saxon lay in an oxygen tent in theinfant ward at Johns. Hopkins Hospital.Even at.rest, the-nine-pound girl's skin

In 1933 Thomasma'rried Clara Flan-

d ers , a ' yo un g'w o ma n' fro m M a co n,

(ie or gia .. T he y-a re p ic tu re d h er e in1941 with their da ughters-Olga Fay

and Theodosi~-both o f ' , w h o _ m wenton to Morgan Sta te 'Co l l eg : e, where

they earnell th e degree thate lu d e -d t h ei r fathe~.

was deeply blue, her lips and nail. bedspurple. Blalock surprised Eileen's pat-ents and his chief resident, Dr. WilliamLongmire, with his bedside announce-ment: He. was "going to perform an op-eration to bI-iogmore blood. to Eileen's

lungs.Ozernight, the tetralogy 'operation

-moved from the lab to the operatingroom. Because there were no needles'small. enough tojoin theinfant 'sarteries;Thomas chopped off -needles from thelab, held.them steady with a clothespin atthe-eye end, and honed new points withan emery block Suture silk f~r human

arteries didn"t exist, so they made dowith the silk Thomas had used in thelab-as- well as the lab' sclamps, fer-cepe.-and right-anglenerve hook.So complete: was the transfer from lab

to operating room-on the morning ofNovember 29, 1944, that-only Thomaswas missing when Eileen Saxon waswheeled into. surgery.' 'I don't think I'llgo," he had said-to chemistrytechnicianClara 'Belle Puryear the 'previous after-noon. "I might make Dr: Blalock ner-

vous-or even worse, 'he-mightmake menervous!"But Blalock wanted Thomas there=

riot watching from the gallery or stand-ing next to the,chief-resident, Dr. Wjl~liam Longmire, .or the intern, Dr. Den-ton Cooley , or next toDr. Taussig atthefoot:of the operating table. Blalock incsisted Thomas stand at his elbow, on astep stool where he could see-what Bla-lock was .doing, After all, Thomas haddone the procedure doze-ns of times;

Blalock only once, as-Vivien's assistant:. Nothing in the laboratory had pre-pared .either one for what they saw when.Blalock opened Eileen's chest. Herblood vessels weren't even half the sizeof those 'in the experirncntalanimalsused to develop the procedure,and theywere full of the thick, dark, "blue"blood characteristic of cyanotic chil-dren. When Blalock exposed the pul-mcnary artery, then the subclavian=-thetwo "pipes" he planned-to reccnnecr+

he turned to Thomas. "Will thesubcla-vian reach the pulmonary once. it's cutoff and divided?" he asked. Thomas'

said it would.Blalock's scalpel moved swiftly to the'

point .of no return. He cut-Into the pul-monary artery, creating theropening into,which he would.sew the divided subcla-vian artery. "Irs the inc ision long

enough?" he asked Thomas. "Yes, ifnot too long, " the reply came:In and out,of the.arteries flashed the

straight -half-inch needle that Thomashad cut and 'sharpened. "Is this all right,Viv,ieli?" Blalock asked as he, beganjoining the smooth inner linings of thetwo arteries. Then, a moment later, withone or two sutures in place: "Are those

bites close enough toge-ther?"Thomas watched. In suchsmall arter-ies, 3' fraction of a millimeter-was criti-cal, and the direction of the sutures de-terinined whether the inside of thevessels would knit properly. If Blalockbegan a suture in the wrong direction,Thomas's voice would come, quietlyover his shoulder: "The other direction,Dr. Blalock. "Finally, off came' the bulldog damps

that had stopped the flow of blood duringthe-operation. The.anastomosis began tofunction, shunting the pure blue bloodthrough the pulmonary artery into the

lungs to.be.oxygenated. Underneath-thesterile drapes, Eileen turned pink."You've never seen' anything so dra-

matic," Thomas' says 00 die tape. "It

wasalmost a miracle.'Almost 'overnight, Operating Room

706 became "the heart room," .as doz-ens of Blue Babies and their parentscame to Hopkins from allover the Unit-ed States, then from abroad, spillingover into rooms on si_xfloors of thehospital. For the next year. Blalock and

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Longmire rebuilt hearts virtually aroundthe clock. One after another, cyanoticchildren who had never been able to situpright began standing at their:crib rails,pink andhealthy.

It was the beginning of modern cardiacsurgery, but to Thomas it looked likechaos .. Blue Babies arrived daily, ·yet

Hopkins had no cardiac ward, no cathe-terization lab, no sophisticated apparatus

for blood studies. They had only VivienThomas, who flew from. one end oftheHopkins complex to the other withoutappearing to.hurry .

From his spot-at Blalock's shoulder inthe operating mom, Thomas would race

to the wards, where he would take arteri-al blood samples on the Blue Babies

Scheduled for surgery, hand off the sam-ples to another technician in the hallway,return to the heart room for the nextoperation, head for the. lab to begin the

blood-oxygen studies, then go back tohis spot inthe OR. .

"Only Vivien is to stand there," Bla-lock would: tell anyone who moved into

the space behind his right shoulder.Each morning at 7:30, the great

screened windows of Room 706 wouldbe thrown open, the electric fan trained

on Dr, Blalock, and the four-inch beamof the portable spotlight focused on the

operating field. At the slightest move-ment of light or fan, Blalock would yellat top voice, at which point his orderlywould readjust both.Then the perspiring 'Professor would

complete the procedure, venting his ten-sion with a whine so distinctive that ageneration of .surgeons still imitate it."Must.I operate all alone? Won't some-

body please help me?" he'd ask plain-tively, stomping his soft white tennisshoes and looking around at the teamstanding ready to execute his every or-der. And lest Thomas I00k away, Bla-lock would plead over his shoulder,"Now you watch, Vivien, and don'tletme put these sutures inwrong!"Visitors had never seen anything like

it. More than Blalock's whine, if wasThomas's presence that mystified thedistinguished surgeons, who came fromall over the world to witness the opera-tion. They could see that the black manon the.stool behind Dr. Blalock was not

an MD. He was not scrubbed in' as, anassistant, and he never touched the pa-tients. Why did the famous doctor keepturning tohim for advice?Ifoutsiders puzzled at Thomas's role,

the surgical team took it as a matter ofcourse. "Who else but Vivien couldhave answered those technical ques-tions?"asks Dr. W.illiam Longmire,

now professor emeritus at UCLA'sSchool of Medicine. "Dr. Blalock wasplowing new ground beyond the hori-

228 TheWash ingtonian/Augus t 1989

zons we'd ever seen before. Nobody

knew how to do this, "

"It was a question of trust," says Dr.Alex Haller, who was trained by Thom-as and [lOW is surgeon-in-chief at Hop-kins. Sooner or later, hesays, all thestoriescircle back to that moment whenThomas and Blalock stood together inthe operating room for the first Blue

In 1971 V ivie n T hom as s to od a t c en -

te r s ta g d o r th e firs t t im e w hen h is

po r t r a i t w as h un g in t he 'o b by o f

J o hn s H o p ki ns '·s B la lo c k B u ild in g , o p -po site the po rtra it o f h is fr ien d a nd

p ar tn er , A lfr ed B la lo ck . F iv e y ea rs

la te r, fo rm a l r ec og nitio n o f T ho m as 's

ach i e vemen t s wascomplete w hen h ew a s a w ard ed a n h on ora ry d oc to ra te

a nd an app~intment to th e

m e d ic a l- sc h o ol f a cu lt y.

Baby. Had Blalock not believed inThomas's lab results with the tetralogyoperation, he would never have dared toopen Eileen Saxon's chest."Once Dr. Blalock accepted you as a

colleague, hetrusted you completely-Imean, with his l if e. " Haller says. Afterhis patients, nothing mattered more toBlalock than his research and his"boys," as he called his residents. ToThomas he entrusted both and, in sodoing, doubled his legacy.

"DLBlalock let.us know in no uncer-tain terms, 'When Vivien speaks, he'sspeaking fOT me,' " remembers Dr.David Sabiston, who left Hopkins in1964 to 'chair Duke University's depart-ment ofsurgery, "We, revered.him aswedid our professor ."To Blalock's "boys;" Thomas be-

came the model of a surgeon. "Dr, Bla-

lock Was a.great scientist, a greatthink-er, a leader, " explains Denton Cooley,"but by no. stretch of the imagination

could he be considered a great cuttingsurgeon. Vivien was. ,,'

What passed from.Thomas's hands tothe surgical residents- who would cometo be kriown as' "the Old Hands" wasvascular surgery in the making=muchof it of Thomas's making. He translatedBlalock's concepts into reality, devisingtechniques, even entire operations,where none had existed.In any other hospital, Thomas's.func-

tions as research consultant and surgicalinstruction mighthave been filled by asmany as four specialists. Yet Thomaswas-always the patient teacher. And henever lost his sense of humor."I remember one .time;" says Haller,

"when I was a medical student, I wasworking ona research project with a se-nior surgical resident who W\lS a very slowoperator. The procedure we were doingwould ordinarily have taken an hour , but ithad taken us six or.seven hours, on this one

dog that had been asleep. all that time.There.I was, in oneposition for hours; and

I was about to.die,"Well, finally, the resident realized

that the dog hadn 'r had any fluids intra-venously, 86 he called over to Vivien,'Vivien, would you come over and ad-minister some I-V fluids?' Now, the

whole time Vivien had been watching usout of the corner of his eye from across

the lab,not saying·a word, but not miss-ing a thing, either. I must have lookedwhite as a'ghost, because when. he cameover with the I-V needle, he sat down atmy foot, tugged at my pants leg, andsaid, 'Which leg shall I start the-fluid-in,Dr. Haller?' "

The man who tugged at Haller's pants

leg administered :one of the country'smost sophisticated surgical.research pro-grams. "He was strictly no-nonsense

about the way he-ran that lab," Hallersays, "Those dogs were treated like hu-man patients; "One of the experimental animals,

Anna, took on legendary status, as thefirst long-term survivor of the Blue Babyoperation, taking up permanent resi-dence in the Old Hunterian as Thomas'spet. It was during "Anna's era," Hallersays, that Thomas became surgeon-in-residence to the pets ofHopkins's facul-ty and 'staff. On Friday 'afternoons,

Thomas opened the Old Hunterian tothe,pet owners of Baltimore and presidedover an afternoon clinicvgaining asmuch prestige in the veterinary commu-nity as be enjoyed within the medicalschool." 'Vivien knew all the senior:vetsin Baltimore, " Haller explains, "and itthey had a complicated, surgical prob-lem, they'd call.on Vivien for advice,or simply ask him to operate on theiranimals. "By the late 1940s, the Old Hunterian

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lad become. "Vivien's domain." sayslRailer. "There was no doubt in any-~~ody'smind as to who was in charge,

~

eChniCa11Y' rion~MD could not holde position of laboratory supervisor.P. Blalock always had someone-on thesurgicalstaff nominally in charge" but itwasVivienwho actually ran the place. "

mg with him. We were operating togeth-er on one occasion, and we got intotrouble with some massive bleeding in apulmonary .artery, which I was able tohandle fairly well. Casper said to me,'Dr. Haller, I was very. much impressedwith the way you handled yourselfthere. ' Feeling overly proud of myself, Isaid to Casper, 'Well, I trained with Dr.Blalock. '

" I t ur ned to him and sa id , 'I

e er ta in ly app re cia te d th e

w ay yqu solv ed thatp ro blem . Y o u h an dled y ou r

h an ds b ea utifu lly .' H e

looked m ein the eye and

sa id , 'I tr ain ed w ith V i vien .' "

••A few weeks later, we were operat-ing together in the lab for a second time,and we got into even worse trouble. Iliterally did not know what to do. Casperimmediately took over, placed theclamps appropriately, and got us out oftrouble. 1 t urned to him at the end of itand said, 'I certainly appreciated theway you solved that problem. YOI J han-dled your handsbeautifully .too.",.He looked me in the.eye and said, 'I

trained with Vivien. ' "

Alfred Blalock .and Vivien Thomas:Their names intertwine, their partner-ship overshadowing the individual Iega-cies they handed down to dozens ofHall-

eIS and Caspers. For more than threedecades, the partnership endured, asBlalock ascended to fame, built upyoung men in his own image, then be-came a proud but reluctant bystander asthey rose to dominate the field he, hadcreated.As close as Blalock was to his

proteges.fhey moved.on, It was Thomaswho remained, the one constant. Fromthe first, Thomas had seen the worst.andthe best of Blalock. Thomas knew thefamous Blue Baby doctor the worldcould not see: a profoundly conscien-tious surgeon, devastated by patient

mortality and keenly aware of his ownlimitations.In 1950, six years .after he and Blalock

had stood together for Blue Baby One,Blalock operated on Blue Baby 1,OOO. l twas a triumphant moment-san occasionthat called for a Yousuf Karsh portrait, asurprise party.at the Blalockhome, giftsof Scotch arid bour:bon,and a long eve-ning of-reminiscing with the Old Hands.Thomas almost wasn't there.As Blalock was laying plans for his

1947 "Blue Baby Tour." of Europe,Thomas was preparing to head hackhome to Nashville, for good, The prob-lem was-money. There was no provisionin Hopkins's salary classification for ananomaly like Thomas: a non-degreedtechnician with the responsibilities 'of apostdoctoral research fellow. .With no regret for the past, the 35-

year-old Thomas took a hard look at thefuture and at his two daughters' pros-

pects for "earning the degrees that hadeluded him. Weighing the Hopkins payscaleagainstthe postwar building boomin Nashville. he decided to head south tobuild houses."It's a chancel have to take," he told

Blalock. «I don't know what will hap-pen .if I leave Hopkins, but I know whatwill happen ifIstay. " He made no sala-ry demards, but simply announced hisintention to leave, -assuming that Blalockwould be powerless 'against the system.Two days before Christrnas 1946,

Blalock came to Thomas in the emptylab with Hopkins's final salary offer,negotiated by Blalock and approved bythe board of trustees that morning. • 'Ihope you will accept this," .he toldThomas, drawing a file card from hispocket. . 'It's the best I can do-it's all Icando. "The offer on the card left Thomas

speechless: The trustees had doubled hissalary and created a new bracket for non-degreed personnel deserving higher pay.From that moment, money ceased to bean issue.

Until Blalock's retirement in 1964, thetwo men continued their partnership.The harmony between the idea man and

the detail man never faltered. Blalocktook care of patients, Thomas took careof research. Only their rhythm changed.In the hectic Blue Baby years, Blalock

would leave his hospital responsibilitiesat the door of the Old Hunterian at noonand closet himself with Thomas fOT afive-minute research update. In theevenings, with Thomas's notes at oneelbow and a glass of bourbonat the.other, Blalock would phone Thomasfrom his study as heworked on scientificpaper~ late into the night. "Vivien, Iwant you to listen to this," he'd saybefore reading twa or three sentences

from the pad in his lap, asking, "Is thatyour impression?" or "Is it all rightifIsay so-and-so?"As the hectic pace of the late '40s

slowed in the early '50s, the hurriednoon visits and evening phone conversa-tions gave way to long, relaxed ex-changes through the open door betweenlab and office.Along the way, Thomas and Blalock

grew old together, Thomas gracefully,Blalock more reluctantly. Sidelined by

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deteriorating health, Blalock decided inthe early 1950s that cardiac surgery wasa young man's field, so he turned overthe development of the heart-lung ma-chine to two of his superstars, Drs. Hen-ry Bahnson and Frank Spencer. Today

Bahnson is chairman emeritus of the de-partment of surgery at the University ofPittsburgh Medical Center, and Spencerchairs the.department of surgery at NewYork University.Blalock told Thomas, "Let's .face it,

Vivien, we're. getting older. Theseyoung fellows can do a much better Jobthan I can. There's no point in my beat-ing myself out with them around.They're good. ' .'But fifteen years at center stage had

made it hard for Blalock to be a bystand-er. At the' end of the 19505, he fumed aspilot.projects fizzled and he and Thomasfell to philosophizing about problems in-stead of solving them. "Damn it, Vi-vien, " he complained, "we must be get-ting old. We talk oursel v es .o ut of doinganything. Let's do things like we used toand find out what happens. "

"You were lucky to have hit the jack-pot twice," Thomas answered, remem-

bering that the good old days were, moreoften than not, sixteen-hour days. Be-sides, it was Blalock, 60 years old, re-cently widowed and in failing health,who was feeling old, not Thomas, thenonly 49. Perhaps Blalock was remem-bering what ithad been like when.he was30 arid Thomas 19, juggling a dozenresearch projects, working into the

night, trying to "find out what hap-pens." By including Thomas in his owndecline, Blalock was acknowledgingsomething deeper than chronology: a

common. beginning.

From 'beginning to end, Thomas and

Blalock maintained a delicate balanceof closeness and distance. A few weeksbefore Blalock's retirement in 1964,they closed oUL their partnenshlp justas they had begun.it-facing each otheron two lab stools. It Was Thomaswho made the first move toward cut-ting the ties, but in the act of releasingBlalock from obligation he acknowl-

edged how inextricably their fortuneswere intertwined."I don't know how you feel about it, "

he said as Blalock mulledOVN

post-retirement offers from around the coun-try, "but I'd JUStas soon younot includeme in any of those plans. I feel as inde-pendent as I did in our earlier years, andI want you to be just as free in makingyour plans. ""Thank you, Vivien," Blalock said,

th:en admitted he had no idea where hewould go or what he would do after his

retirement. "If you don't stay at Hop-kins," he told Thomas, "you'll be able

230 The Washingtonian/August 1989

to writeyour own ticket, wherever youwant togo.""Thanks for the compliment,"

Thomas smiled, "but I've been here forso long ldon't know what's going on in

the outside world. "Weeks after the last research project

had been ended, Blalock and Thomasmade one final trip to the "heartroom" -not the Room 706 of the early

L evi W atkin s, H opk in s's firs t b la ckc ard ia c res id en t, s ha red a b 'o nd w ith

V iv ien T ho m as th at tra ns cen de d th eir34 .ye ar a ge d iffe re nc e. W atkin s

c am e to ch er is h th e fa th -e rly a dvic e h e

r e ce i v ed "'rom a m a n who' k new what

it w as like to be th e only one,"

days, but a glistening new surgical suiteBlalock had built with money from the

now well-filled coffers of the depart-ment of surgery. The Old Hunterian,too, had been replaced bya state-of-the-art research facility.By this 'time, Blalock was dying of

ureteral cancer. Wearing a back-brace astheresuIt of a disc operation, he couldbarely stand. Down the seventh-floorhallway of the Alfred Blalock ClinicalSciences Building they Went: the white-haired Professor in his wheelchair; thetali, erect blackman slowly pushing him

while others rushed past them into theoperating rooms.Just before they reached the exit from

the main corridor to the rotunda where

Blalock's portrait hung, he asked Thom-as to stop so-that he could get out of hiswheelchair. He would walk out into therotunda alone; he-insisred.

"Seeing that he was unable to standerect, ". Thomas recalled later, "I asked

ifhe wanted me to accompany him-to thefront ofthehospital. His reply was, 'No,

don't.' I watched as with an almost 45"degree stoop and obviously in pain; heslowly disappeared through the exit. "Blalock died three months later.

During his final i llness Blalock said to acolleague: "Ishould have found a wayto send Vivien to medical school." It

was the last time he would voice thatsense of unfulfilled obligation."Time and again, to one or another of

his residents, Blalock had faulted him-

self for not helping Thomas to get amedical degree. Each timecrernembersDr. Henry Bahnsen, "he'd comforthimself by saying that Vivien was doingfamously what he did well, and that hehad come a long way With·Blalock's

help. "But Thomas bad not come the whole

way. He had been Blalock's "otherhands" in the lab. had enhanced TheProfessor's stature, had shaped dozensof dexterous surgeons' as Blalock himselfcould not have-but a price had beenpaid, and Blalock knew it.Blalock's guilt was in no way dimin-

ished by his knowing that even with amedical .degree, Thomas stood little

chance of achieving the prominence ofan OldHand. His prospects in themedi-cal establishment of the I940s were

spelled out by the only woman amongBlalock's "boys,'" Dr. Rowena Spen-

cer, a pediatric surgeon who as a medi-cal student worked closely with Thomas.In her commentary on Thomas; s ca-

reer, published this year in A Century of

Black Surgeons, Spencer puts to rest thequestion that Blalock wrestled with dec-ades earlier. "It must have. been Saidmany times," Spencer writes, "that 'if

only' Vivien had had a proper medicaleducation he might.have accomplished agreat deal more, but the truth of the

matter is that as a black physician in thatera, he would probably have had tospend all his time and energy making aliving among an economically deprivedblack population. "

What neither Blalock nor Thomas couldsee as they parted company in June 1964in the seventh-floor hallway of the Bla-

lock Building was the rich recognitionthat would come' to Thomas' with thechanging times.

It was the admiration and affection ofthe men he trained that Thomas valued

most. Year after year, the. Qld Handscame back to visit, one at a time, and onFebruary 27, 1971, all at 'once. Fromacross the country they arrived, packingthe Hopkins auditorium to present theportrait they had commissioned of "'our

colleague, Vivien Thomas. "For the first time in 41 years, Thomas

stood at center stage, feeling "quitehumble. " he said, "'butat the same

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time, just a little bit proud. " He rose tothank the distinguished gathering, hissmiling presence contrasting with the se -rious, bespectacled Vivien Thomas inthe portrait."You all have got me working on the

operator's side of the' table this morn-

ing," he told the standing-room-only au-dience. "It's always just a few degreeswarmer on-the operator's side than it ison his assistant 's, when you get into theoperating room!"

Thomas's portrait was hungoppositeThe Professor's in the lobby of the Bla-lock Building, almost 30 years from theday in 1941 that he and Blalock hadcome to Hopkins from Vanderbilt.Thomas, surprised that his portrait hadbeen painted at all, said he was' 'as-tounded" by its placement. But it wasthe words of hospital 'president Dr. Rus-sell.Nelson that hit home: "There-are all

sorts of-degrees and diplomas andcertif-

icates, but·nothing equals recognition byyour peers. "

Five years later, the recognition ofVivien Thomas's achievements was

'Completewhen 'Johns Hopkins awardedhim an honorary doctorate and an ap-pointment to the medical-school faculty.

Thomas's wife, Clara, still refers to herhusband's autobiography by Vivien's ti-tle, Presentation 0 / a Portrait: The Storyof a Life, eyen though when itappearedin print two days after his death in 1985,it bore the more formal title of Pioneer-ing Research ill Surgical Shock and Car-diovascular Surgery: Vivien Thomas aridHis Work With Alfred Blalock. It is to herthat the book is dedicated, and it was inher arms that he died, 52 years after their

marriage.Clara Thomas speaks proudly 'of her

husbarid's accomplishments, and mat-ter-of-factly .about the recognition thatcame late in his career. "After ali, he~ould have worked all those' years andgotten nothing at all," she says, lookingat the Hopkins diploma hanging in acomer of his study. "Vivien TheodoreThomas, Doctor 'of Laws;" it reads, aquiet reminder of the thunderous ovationThomas received. when he stood in hisgold-and-sable academic robe on May21, 1976, for the awarding of the de-gree. "The applause was so great that I

felt very small, "'Thomas wrote.It is not Thomas's diploma that guests

first see when they visit the family'shome, but row upon row of children's

and grandchildren'S graduation pictures.Lining the walls of the living room, twogenerations in caps and gowns tell diestory of the degrees that mattered moreto Thomas than the one he gave up and.the one he finally received.At the Thomas home, the signs of

Vivien's hands are everywhere: in the

backyard rose garden, the mahoganymantelpiece he made from an old pianotop, the Victorian sofa.he upholstered,the quilt his mother made from a designhe had drawn when he was nine years

old.

The book was the last work of VivienThomas's life, and probably the mostdifficult., Itwas the: Old Hands' relent-

V ivie n T hom as d id n't live to s ee h is

nephew , K oco Ea to n, g ra du ate fro m

H opkin s M ed ic a l S ch oo l in 1987 , bu t

h e re jo iced a t his ,admission, E a t o n

w as tra in ed a s a s u li·in te rn in sur-g er y u n de r th e m en h is unele ha d

tr ain ed a g en er atio n e ar lie r.

less campaign that finally convinced Vi-vien to turn his boxes of notes and filesinto an autobiography. He began writingjust after his retirement in 1979, work-ing through his illness with pancreaticcancer, indexing the book from his hos-pital bed following surgery, and puttingit to rest, just before his death, with a1985 copyright date.Clara Thomas turns to the last page of

the book, to a picture of Vivien standingwith two young men, one a medicalstu-dent, the other a cardiac surgeon. It was

the· surgeon whom Clara Thomas and

her daughters asked to speak at Vivien'sfuneral.He is Dr. Levi Watkins, and the diplo-

mas on his office wall tell a story. Wat-kins was an honors graduate of Tennes-see State, the first black graduate ofVanderbilt University Medical School,and Johns Hopkins's first black cardiac

resident. Levi Watkins Jr. is everythingVivien Thomas might have been had hebeen born 40 years later.That was what he and Thomas talked

about the day they met in the hospitalcafeteria, a few weeks after Watkins had

come to Hopkins as an intern in 1971."You're the man in the picture," he hadsaid. And Thomas had'smiled and invit-ed him up to his office ."He was so modest that Ihad to keep

asking him, 'What did you do to get yourpicture on the wall?' " says Watkins ofhis first meeting with a-man who was forfourteen years "a colleague, a coun-selor, a friend. "

"Even though Inly knew him a frac-tion of the time some of the other sur-geons did, Ielt very close to him. Fromthe very beginning, there was this deeperbond between us: Iknew that he hadbeen where Ihad been, and Ihad beenwhere he could not go. "Both men were aware that their differ-

ences ran deep: Watkins, whose expo-sure to the early civil-rights movementas a'parishioner of the Reverend MartinLuther King Jr. had taught him to be"out front and vocal about minority par-

ticipation"; and Thomas, whose up-brlnging.in Louisiana and Tennessee in

the early years ·of the century had taughthim the opposite."Ihink Vivien admired what I did,"

says Watkins, "but he knew that wewere different. There was a generation'sdifference between Vivien and me, andit was a big generation. Survival was amuch s_tronger element in his 'back-ground. Vivien was. a trailblazer by his

work. "Watkins holds part of Thomas's lega-

Gyin his hand as he speaks, a metal boxcalled an Automatic Implantable Defi-brillator. No larger than a cigarettepackage, Watkins's AID is deceptively

simple-looking. From inside a patient'sbody, it monitors the heartbeat, shock-ing the heart back into normal rhythmeach time it fibrillates."It was Vivien who, helped me to

work through the problems of testingthis thing in the dog lab," says Watkins,turning the little half-pound "heartshocker" in his hand and running hisfingers a lo ng its two electrode wires. "It

was my first research project when I"joined the medical faculty, and Vivien'slast. ' ,' Only months after Thomas's re -

tirement in 1979,Watkins performed thefirst human implanration of the AID,

winning.a place in .the long: line of Hop-kins cardiac pioneers.

But more than science passed from manto man over fourteen years. In the 60-year-Old Thomas, the 26-year-Old Wat-kins'. found a man with, the ability totranscend the times and the circumspec-tion to live within them. In their longtalks in Thomas's office, the young sur-geon remembers that "he taught me totake the.broad view, to try to understand

Augus t 1989fThe Wash ing ton ian 231

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D Hopkins and its perspective on race, .Hetalked about how powerful Hopkinswas, how traditional. He was concernedwith my being too political and antago-nizing the people Iad to work with. Hewould check on me from time to time,just. to make sure everything was all,right. He worried about my getting outthere alone. "

It was. "fatherly advice," Watkins

"T he foreman said ,

'T h omas, y ou co uld have

fixed that floor r ight in the

first place.' Iknew that Ihad

le ar ne d th e le sson Itill tryto adhere to : Whate .ver youdo, alw ays do your best."

says fondly, "from a man who knewwhat it was like to be the only one."

When Thomas retired, one era endedand another began, for that was the year

that Levi Watkins joined the medical-school admissions committee. Withinfour years, minority enrollment quadru-

pled. "When Vivien saw the number ofblack medical 'students increasing sodramatically, he was happy-he was

happy, " saysWatkins.

Always one. for gentle statements,Thomascelebrated the changing timeson the last page of his book: Thomas isshown standing proudly next to LeviWatkins 'and a 'third-year medical stu-dent named Reginald Davis, who is

holding.his infant son. According to thecaption, the photograph was taken in1979 in front O f the hospitat.s Broadwayentrance. But the true message lies inwhat the caption does not say: In 1941,the Broadway entrance was for whitesonly.

Had the photograph been taken eightyears later, it might have includedThomas's nephew, Koco Eaton, a 1987

graduate of the Johns Hopkins MedicalSchool, trained as a sub-intern in sur-

gery by the men his uncle had trained ageneration earlier. Thomas did not liveto see his nephew graduate; but he re-

joiced at his admission, "I rememberVivien coming to me in my office, " saysWatkins, "and telling me how much itmeant to him to have all the doors open

for Koco that had been closed to him."Up and 'down the halls.of Hopkins,

Koco Eaton turned heads-not becausehe was black, but because he was the

nephew of Vivien Thomas.

It wason a summer afternoon in 1928

that Vivien Thomas says he Ieamed the

standard of perfection that won him somuch esteem. He Was just out of high

school, working on the Fisk Universitymaintenance crew to earn money for hiscollege tuition. He had spent all morn:ingfixing a piece of worn flooring in on e ofthe faculty houses. Shortly after noon,the foreman came by toinspect."He took one look," Thomas remem-

b-ered, and said, 'Thomas" that won't do,Ican tell you put it in. ' Without anotherword, he turned and left. Iwas stung, butIreplaced the piece of flooring. Thistime Iould barely discern which pieceIhad put in .... Several days later theforeman said to me, 'Thomas, you couldhave fixed that floor right in the firstplace.' Iknew thatIhad already learnedthe lesson whichItill remember and tryto adhere to: Whatever you do, always

'do your best. ... Iever had to repeat orredo.another assignment. "So it went for more than halfa centu-

ry. "The Master," Rollins Hanloncalled him the day he presented Thom-

as's portrait on behalf of the Old Hands.Hanlon, the surgeon and scholar, spoke

of Thomas's hands, and of the man whowas greater still; of the synergy of twogreat men, Thomas and Blalock.Today, in heavy gilt frames, those

two men silently look at each otherfrom opposite walls of the BlalockBuilding, just as one morning 40 yearsago they stood in silence at Hopkins.Thomas had surprised The Professorwith an operation he' had conceived,then kept secret until healing was corn-pleted. The first and o-nly one con-ceived entirely by Thomas, it was acomplex but now common operation

called an atrial septectomy.

Using a canine model, he had found away to improve circulation in patientswhose great vessels were transposed,The problem had stymied Blalock formonths, and now it seemed that Thomas

had solved it."Neither he nor Tspoke for some four

or five minutes while be stood there ex-

amining the heart, running the tip of hisfinger back and forth through the moder-ate-size defect in the atnial.septum, feel-ing the healed edges of the defect. . . .We examined the outside of the heartand found the suture line with most ofthe silk still intact. This was the .only

evidence that an incision had-been madein the heart."Intemalhealing .of the incision was

without flaw. The sutures could not be

seen from within, and on gross examina-tion the edges of the defect were smoothand covered with endocardium. Dr.Blalock finally broke the silence by ask-ing, 'Vivien, are you sure you did this?'I answered in the affirmative, and thenafter a .pause he said, 'Well, this looks

like something the Lord made.' " (J

A ugust 1989fT he W ash ington ian 233